血清感染指标对颈后路单开门椎管扩大成形术后早期感染的诊断价值

摘    要：

目的：探讨白细胞计数（WBC）、C-反应蛋白（CRP）、血清降钙素原（PCT）及红细胞沉降率（ESR）水平对颈后路单开门椎管扩大成形术后早期感染的诊断价值，及时发现、预防和治疗术后感染患者。方法：回顾性分析2010年1月至2019年4月颈后路单开门椎管扩大成形术后早期发热的患者120例；按照患者伤口渗出液细菌学培养的结果将其分为感染组（53例）和未感染组（67例），感染组中，男32例，女21例，年龄48～63(52.28±6.36）岁；未感染组中，男37例，女30例，年龄46～62(51.63±5.82）岁。并根据感染组患者术后感染类型将其分为深部手术部位感染组（30例）和浅表手术部位感染组（23例），深部手术部位感染组中，男19例，女11例，年龄50～63(53.16±5.62）岁；浅表手术部位感染组中，男13例，女10例，年龄48～61(52.15±5.68）岁。比较组间患者及组内患者手术前后WBC计数、CRP、PCT及ESR血清感染指标。收集纳入的120例患者血清感染学指标数据并根据血清感染指标诊断感染的灵敏度及特异性，以1-特异性为横坐标，灵敏度为纵坐标绘制受试者工作特征（ROC）曲线对WBC计数、CRP、PCT以及ESR感染指标进行早期感染诊断的准确性评估。结果：术前：感染组和未感染组患者的WBC计数、CRP、PCT、ESR血清感染指标水平相近（P>0.05）；术后：感染组患者的WBC计数、CRP、PCT、ESR感染指标较未感染组高（P<0.05）。在术后感染的患者中，WBC计数、CRP、PCT以及ESR血清感染指标水平在不同术后感染类型的患者中存在差异（P<0.05）。未感染组患者的WBC计数、CRP、PCT以及ESR血清感染指标总体呈现出先升后降的趋势。WBC计数感染指标的受试者曲线下面积（AUC）为0.637(P<0.05);CRP感染指标的AUC为0.792(P<0.05);PCT感染指标的AUC为0.774(P<0.05);ESR感染指标的AUC为0.783(P<0.05）。结论：WBC计数、CRP、PCT、ESR血清感染指标可用于颈后路单开门椎管扩大成形术后早期感染的诊断，除此之外，上述4种感染指标变化的综合分析可用于不同术后感染类型的鉴别。WBC计数指标对于早期感染诊断的准确性较低，CRP、PCT以及ESR指标对于早期感染诊断的准确性较好。总体上来说，CRP、PCT以及ESR血清感染指标对于颈后路单开门椎管扩大成形术后早期感染的诊断来说具有重要的临床意义，有助于临床工作者尽早发现术后早期感染以利于随后的相应治疗。

Abstract：

Objective:To investigate the diagnosis value of white blood cell(WBC) count,C-reactive protein(CRP),serum procalcitonin(PCT) and erythrocyte sedimentation rate(ESR) levels for early infection after posterior cervical expansive open-door laminoplasty.Discover,prevent,and treat postoperative infections promptly.Methods:The clinical data of 120 patients with early fever after posterior cervical laminoplasty from January 2010 to April 2019 were retrospectively analyzed.According to the results of bacteriological culture of wound exudate,the patients were divided into infected group(53 cases)and non-infected group(67 cases).In infection group,there were 32 males and 21 females,aged from 48 to 63 years old,with an average of(52.28±6.36) years.In non-infected group,there were 37 males and 30 females,aged from 46 to 62 years old,with an average of(51.63±5.82) years.According to the postoperative infection types,the patients in infection group were divided into 30 cases of deep surgical site infection group and 23 cases of superficial surgical site infection group.In deep surgical site infection group,there were 19 males and 11 females,aged from 50 to 63 years old with an average of(53.16±5.62)years.In superficial surgical site infection group,there were 13 males and 10 females,aged from 48 to 61 years old with an average of(52.15±5.68) years.WBC count,CRP,PCT and ESR serum infection indexes were compared between groups and within groups before and after surgery.The serum infective index data of 120 patients were collected and the sensitivity and specificity of the serum infectious index were used to diagnose the infection.Accuracy assessment of early infection diagnosis of WBC count,CRP,PCT and ESR serum infection indexes by plotting the receiver operating characteristic(ROC) curve with 1-specificity as the abscissa and sensitivity as the ordinate.Results:There were no significant difference in WBC count,CRP,PCT and ESR serum infection indexes between infected group and non-infected group before operation(P>0.05).Postoperative WBC count,CRP,PCT and ESR infection indexes in infection group were higher than in non-infected group(P<0.05).Among patients with postoperative infection,WBC count,CRP,PCT and ESR serum infection index levels were significantly different in the different postoperative infection types(P<0.05).In non-infected group,WBC count,CRP,PCT and ESR serum infection indexes showed an overall trend of rising first and then falling.The area under curve(AUC) of WBC count infection index was0.637(P<0.05).The AUC of CRP infection index was 0.792(P<0.05).The AUC of PCT infection index was 0.774(P<0.05).The AUC of ESR infection index was 0.783(P<0.05).Conclusion:WBC count,CRP,PCT and ESR serum infection indexes can be used for the diagnosis of early infection after posterior cervical expansive open-door laminoplasty.In addition,the comprehensive analysis of the changes of the four infection indexes can be used for the identification of different postoperative infection types.WBC count index is less accurate for early infection diagnosis,and CRP,PCT,and ESR indexes are more accurate for early infection diagnosis.In general,CRP,PCT and ESR serum infection indexes have important clinical significance for the diagnosis of early infection after posterior cervical open-door laminoplasty,which helps clinicians to detect early postoperative infection as early as possible to facilitate subsequent treatment.